Sean and Christian are reunited with an old friend, Julia bonds with Sofia Lopez, and Christian and Gina clash over their differences in opinion concerning Gina's pregnancy.

Christian learns that Kimber and Merril are engaged. Escobar continues to have the surgeons do things for him. Liz is sent to Bermuda after being shot in the leg by one of Escobar's people. Sean goes to kill Escobar. Escobar makes a deal with Sean; a new face for their freedom. Christian learns, in the delivery room, that he is not the father of Gina's baby. Julia returns to get the paternity test she had done a while ago. The doctors do surgery on Escobar, and give him the face of a criminal even higher than Gallardo on the Most Wanted List - Armand Ortiz. Ortiz is arrested at the airport for bank robbing and killing a federal agent.

Joan Rivers consults with Sean and Christian to have all of her plastic surgeries undone, because she wants her grandson Cooper to learn that you don't have to be perfect. When she ultimately learns what she will turn out like after the work has been finished, she decides to give up on her original plan and asks the doctors to schedule her for a facelift the next morning. Matt is concerned about Ava, who seems obviously depressed. He suggests they go away to Paris and start a new life together, which she reluctantly accepts after some convincing. Matt goes to McNamara-Troy to steal drugs for her to take with them. Christian finds him, and gets upset when he learns Matt is going to Paris. Christian goes to have a talk with Ava, and when trying to make a point using sex, he learns that Ava is really a transsexual. Julia, Sean, and Christian spend the night researching, and trace their way to Maryland and a Gender Reassignment center.

After having a nipple bitten off by her dog, Shari Noble comes in to have it reconstructed before her husband returns from Iraq. Julia meets a breast-feeding expert. Christian and Liz hit a lesbian bar where Christian tries to attract one of the women there but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for one of their patients.

Sean soon discovers that Monica Wilder doesn't intend to leave him alone. Christian's therapist has an obsessive torment to reveal. And Burt Landau proposes an unusual solution upon learning that Christian and Michelle are having an affair.

Dr. Merrill Bobolit, who's out of jail, needs Sean's and Christian's professional services. Escobar Gallardo wants them to perform surgery on his face. And Matt tells his family that he's married and that he and his wife are expecting a baby.

Sean contrives to sell his portion of the practice; Michelle's connection with James finally ends, but not with James' boss; Gina is not happy to discover about Michelle's role in Wilbur's life; Matt tries to rekindle the spark with Kimber; and Poppy and Liz break up.

Sean considers selling his shares of the practice to Christian and Michelle, although Michelle's past starts to threaten her future with Christian. Meanwhile, Escobar's wife needs cosmetic surgery.

The teenage daughter of Escobar Gallardo seeks out Sean and Christian for answers about her late father, stirring tremendous guilt within Sean. A seemingly common cosmetic procedure for a struggling actress leads to chaos.